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Abstract

Echocardiographic determination of severity of mitral insufficiency is of prognostic importance. Patients with an effective regurgitant orifice (ERO)of ≥ 40mm2 have a guarded prognosis, which lead to a recommendation of mitral valve surgery even in asymptomatic patients. According to ESC/AHA Guidelines a pulmonary artery pressure at rest of >50mmHg or 60mmHg during exercise are an indication for surgery in asymptomatic patients with severe MI by Echo.

Goal of this study was, to examine the hemodynamic impact of a severe Echo-MI with a Swan-Ganz balloon tipped catheter at rest and during submaximal supine bicycle ergometry to identify patients who fulfill AHA/ESC criteria for mitral valve surgery. In 219 patients with severe MI (mean age 59,4±0,8yrs, 72%male) exercise hemodynamics with pulmonary artery systolic pressure at rest (PAPsR) and during exercise(PAPsEx) could be evaluated.

Results: The PAPs at rest was in 180/219 patients(82%) below 50mmHg, 108(60%) of which developed a PAPs of >60mmHg during exercise.

Conclusion Exercise hemodynamics identify patients fulfilling criteria for mitral valve surgery, who are not identified by resting hemodynamics. Exercise hemodynamics can be helpful in the decision for surgery particularly in asymptomatic patients with PAPs < 30 mmHg at rest. This applies also for Pts in whom PAPs can not be determined by echo at rest.